Remedinet Technologies

Remedinet was profiled in the August 2016 issue of Insurance Times Magazine

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Have proper paperwork to cover dependant under employer policy

This article was first published in Mint Money.

Shyamal Banerjee/Mint

Shyamal Banerjee/Mint

Health insurance adoption, utilisation, and administration each pose a unique set of challenges for various stakeholders—insurance companies, third-party administrators (TPAs), regulators and government bodies, and hospitals—of the insurance ecosystem. Seamless individual processes and functions from each of the stakeholders that come together cohesively can provide customers with a health insurance cover that they can use without experiencing a financial crisis for the treatment.

Over the last decade or so, corporate group health insurance covers, offered by employers to their employees, has come to form a significant chunk of health insurance penetration in India. Under such a policy, not only is the employee covered, (depending on the policy terms) their dependents such as spouse, children and parents are also covered. The sign up process involves the employee submitting forms that contain the employee’s and her dependents’ details to the human resources (HR) department, which in turn consolidate and send the information to the insurance company or the TPA. Following this, the health insurance policy ID cards are handed over to the employee.

In most cases, corporate policies are cashless health insurance policies, wherein the patient is not required to pay upfront cash and the bill is settled between the hospital and the payer or the TPA (with a small percentage of copayment or exceptions not covered under the policy being borne by the patient). At the hospital, the claim is processed by the hospital TPA desk, which coordinates with the TPA who adjudicates the claims on behalf of the insurer to settle the insurance claim against the bill. Thus, pre-authorisation of the sum payable and patient’s eligibility are processes that rely on the information shared by the patient at the time of sign up.

In the case of a dependent, to utilise the policy, they have to be enrolled as dependents in the TPA systems. In many cases, dependents are not enrolled in the TPA systems even though the relevant forms may have been filled in the beginning. Owing to various reasons including, the use of unstructured communication channels between HR and the insurer or the TPA, this information does not flow to the TPAs. Thus, even though the employee may have filled the forms to include dependents under the employee provided cover, there can be significant delays in receiving the approvals from the TPA leading to avoidable heartburn and stress for the policyholder at the time of availing the treatment.

In such scenarios, the primary policyholder and her dependents using the policy for treatment are likely to face problems such as the ones mentioned below:

Difficulty in enrolment: To get the dependent enrolled with the TPA, the primary policyholder will have to get in touch with all parties involved—the HR team with the employer, the insurance company, and the TPA. Various rounds of back and forth involving calls and e-mails, documentation with each and response time that can go up to several hours derails the treatment and adds to the patient’s woes.

Mounting costs: As a result of the added time (and days) spent in getting the insurance procedure going, along with delays at all stages, the time spent at the hospital can potentially escalate costs or there may be a need to make a deposit to the hospital upfront due to lack of approval from the TPA. This, in turn, can add unnecessary costs to your final bill and become a financial burden that could have otherwise been avoided.

What should the primary policyholder do?

To ensure that the dependents are enrolled in the TPA systems, it is best that the employee follows up with the relevant department and the company’s HR team to get a confirmation regarding this as soon as sign-up is completed.

This will ensure that in the unfortunate situation of a medical need for any of the dependents, precious time is not lost. At the time of crisis, the primary member and her family does not have to go through a bad experience while availing cashless treatment. Taking a few precautions and being prepared for such situations can help policyholders greatly reduce the stress related to availing insurance.

While the health insurance ecosystem gears up to adopt electronic platforms, it is wise for the policyholder to take necessary precautions to ensure that this does not add to the worries and stress at the time of any hospitalisation.

Munish Daga, chief executive officer, Remedinet Technologies Pvt. Ltd.

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Speciality clinics looking to healthtech startups for IT upgrades

This article was first published in the Times of India.

CHENNAI: Hospital chains like the Apollo Group, Manipal, Columbia Asia and Fortiswere among the first in India to invest heavily in IT. Joining their ilk are speciality clinics like Vasan Eyecare, Davita, Narayana Health, HCG and Agwaral Eye Clinic, which now taking to the IT highway and upgrading to ICD10 code compliance, payment-facilitating web portals, creating mobile apps, maintaining electronic health records and booking doctors’ appointments.

Startups like Remedinet, S10 Healthcare, Medi Assist are coming to the rescue of such speciality clinics for cancer, cardiac, dental and eye care. Medi Assist, which recently invested $1 million in Goa-based mobile fitness venture MobieFit, has come up with MediBuddy, a mobile app for hospitals and specialty clinics. The mobile app allows policyholders to raise and track claims, plan an e-cashless hospitalization, search networked/empanelled hospitals, book wellness services, buy drugs and maintain electronic health records. “We also have e-cashless, which helps users book cashless admission at a network hospital using their smartphones. You can choose the room type, get an idea as to projected bill, cost of treatment, and cut out waiting time for hospital admission,” said Prashant Jhaveri, head, products and strategy, Medi Assist Healthcare Services, which also has a MediBuddy web portal for access to health benefits.

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Our platform cuts claim adjudication time by 50%

This article was first published in Mint on 24th July.

 

Photo: Hemant Mishra/Mint

For health insurance to be truly cashless, it’s important that hospitals and insurers talk to each other in real time. Remedinet Technologies Pvt. Ltd is a cloud-based platform that aims to simplify the back-end of cashless claims by connecting hospitals to the insurers. Munish Daga, chief executive officer of the company, spoke to Mint and explained how the platform reduces the turn-around time on claims settlement.

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Cashless health plan better than reimbursement

This story was first published in the Financial Chronicle on March 15.

Being aware and staying informed about health insurance is as important as having a health insurance policy. The decision you make should be an informed one with all the options on the table. Incidences of individuals being miss-sold and claims getting rejected are plenty.

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Health Insurance in 2016: Will the consumer be king?

This story was first published in the January issue of Express Healthcare.

Munish Daga, CEO, Remedinet recommends using the mobile phone as a medium to improve health insurance coverage in the coming year

201601ehm65Keeping the current government’s Universal Health Assurance Mission (UHAM) in mind, a solution that promotes universal healthcare will have to use technology in a way that is simple and robust, as well as scalable. The focus needs to be on a solution that aims to bring the consumers – the beneficiaries into the loop and enables them with the ability to use as well as monitor their health policy with minimum hassles and maximum transparency. More importantly, this solution should be able to make a scheme such as UHAM accessible to every single citizen of the country. And, that is the prediction for healthcare insurance, not just for 2016 but also for the foreseeable future.

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Using Technology To Aid Cashless Payments In Hospitals – Remedinet

This post was first published on Networked India in December.

India’s healthcare insurance segment remains a largely untapped market for new technologies, but its adoption rate is on the rise. Gross written premiums grew by 16% in 2012-2013 to Rs 15,341 crore. Although this rise is good news for the country, the hassle of filing an insurance claim when you/family member falls ill, still continues. The typical processes are done manually, where patients get physical copies of reports, scan them and then upload them. Cashless payments take plenty of time to be cleared and only account for about 30% of the insurance market.

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